User:Thomas Pain 67/sandbox

President Barack Obama came to office during an economic crisis, as he has reminded us a time or two. Those were very tough days, and any fair measure of his record has to take that into account. My home state voted for President Obama. When he talked about change, many people liked the sound of it, especially in Janesville, where we were about to lose a major factory.

A lot of guys I went to high school with worked at that GM plant. Right there at that plant, candidate Obama said: “I believe that if our government is there to support you … this plant will be here for another hundred years.” That’s what he said in 2008. Well, as it turned out, that plant didn’t last another year. It is locked up and empty to this day. And that’s how it is in so many towns today, where the recovery that was promised is nowhere in sight.

Nstrauss, I'll use a condensed version of the wiki definition of the "lead" to make a few points:

... The lead serves as an introduction to the article and a summary of its most important aspects. The lead should be able to stand alone as a concise overview. It should define the topic, establish context, explain why the topic is notable, and summarize the most important points—including any prominent controversies. The emphasis given to material in the lead should roughly reflect its importance to the topic, according to reliable, published sources, and the notability of the article's subject is usually established in the first few sentences. Significant information should not appear in the lead if it is not covered in the remainder of the article. .... the lead should not "tease" the reader by hinting at—but not explaining—important facts that will appear later in the article. The lead should normally contain no more than four paragraphs, be carefully sourced as appropriate, and be written in a clear, accessible style with a neutral point of view...

Define the topic: Who-what-when, including the ACA and "Obamacare" clarifications.

Establish context, explain notability: US healthcare system is broken. Rising costs, emergency room problem, Medicare unsustainable, Democrat goal since 1948(?), narrowly passed by partisan vote.

Most important aspects, : Reduction of uninsured people, subsidies, coverage changes, preventive care, impact on premiums, cost to government/revenue enhancements/fiscal impact.

prominent controversies: Constitutionality/legal challenges, efforts to repeal, Religious freedoms, size of government/States rights, Individual mandate, tax increases, single-payer vs private insurance, wealth redistribution, impact on Medicare Advantage, burden on small business/job creation....(pick a few from the list...)

Emphasis given: I think the "controversies" deserve at least 1/3 of the emphasis; I know it is supposed to be based on what the RSs are talking about, but I don't know how to guage that. A survey of the article's citations doesn't work for me, as they support what I consider to be a one-sided article... Also, the fiscal impact of the bill deserves a lot more emphasis than it now receives. Government spending and debt are central to the politics of the nation at this time, and this Act is a posterchild for that issue.

lead should not "tease": This is why you need to list in general terms the controversies, rather that simply say it is controversial. I continue to believe that the Supreme Court ruling needs to be described in some detail for the same reason.

neutral point of view:NPV cannot be achieved if the controversies are ignored. NPV cannot be achieved if the financial details of the Act are glossed over. NPV cannot be achieved if the Act is descibed in "pro" half-truths.

Regarding RECENTISM and the 10YT:

Excerts from the Wiki article:


 * ...After "recentist" articles have calmed down and the number of edits per day has dropped to a minimum, why not initiate comprehensive rewrites? Many articles can be condensed to keep only the most important information, the wider notable effects of an event, and links to related issues. Much of the timeline and the day-to-day updates collected in the "rough draft" stages can safely be excised....


 * Just wait and see. Remember, there is no deadline. Editors writing today do not have a historical perspective on today's events, and should not pretend to have a crystal ball.

In my opinion, as the number of edits has not dropped to a minimum, it makes sense to just wait and see, and then make a comprehensive edit when the dust has settled. To do otherwise suggest that a crystal ball is telling us that the controversy will imminently fade into oblivion.

In closing; I am only asking that undecided voters be included in the audience, not that they are the exclusive audience, I don't propose that the article focus only on the controversy, and I think I have been very clear about by personal bias and that I respect the need for reliable sourcing of all content.

What I really want to know is whether you, and others that may read this, find any merit in my position that there is a bias in the present lead, and if there is, are you willing, as capable editors, to work to correct the problem?Thomas Pain 67 (talk) 10:39, 11 August 2012 (UTC)

According to The New York Times, the term "Obamacare" was first put in print in March 2007 when health care lobbyist Jeanne Schulte Scott used it in a health industry journal. She wrote "We will soon see a 'Giuliani-care' and 'Obama-care' to go along with 'McCain-care,' 'Edwards-care,' and a totally revamped and remodeled 'Hillary-care' from the 1990s" .[2][249] According to research by Elspeth Reeve at The Atlantic magazine, initial uses, in early 2007, were generally by writers describing candidate Obama’s proposal for expanding coverage for the uninsured .[244]

In May 2007, Mitt Romney was first to use the term in a political speech. In Des Moines, Iowa, Romney said: "In my state, I worked on health care for some time. We had half a million people without insurance, and I said, 'How can we get those people insured without raising taxes and without having government take over health care'. And let me tell you, if we don't do it, the Democrats will. If the Democrats do it, it will be socialized medicine; it'll be government-managed care. It'll be what's known as Hillarycare or Barack Obamacare, or whatever you want to call it."[2]

By mid-2012 it was a generally accepted term, meant to encompass all healthcare legislation passed during the Obama administration.[244] Use of the term in a positive sense was suggested by Democratic politicians such as John Conyers (D-MI).[245] President Obama later said, "I have no problem with people saying Obama cares. I do care."[246] In March 2012, the Obama reelection campaign embraced the term "Obamacare", urging Obama's supporters to post Twitter messages that begin, "I like #Obamacare because...".[248  ] On the negative side, HR6079: Repeal of Obamacare Act, passed the house of representatives in July 2012. }}

According to an analysis by the Sunlight Foundation, the term "Obamacare" has been used nearly 3,000 times since its debut as a phrase on Capitol Hill in July 2009.[2] Because of the number of "Obamacare" search engine queries, the Department of Health and Human Services purchased Google advertisements, triggered by the term, to direct people to the official HHS site.[247]

Re the "ruling" on the Medicaid expansion, see the discussion here and here. I don't see anything wrong with simply saying that the Court "largely upheld" the constitutionality of PPACA, that is correct and sufficient for the purpose of the lead section of this article. Re the half-truths you have read, why don't you identify each on specifically and we can discuss them individually? --Nstrauss (talk) 03:42, 30 July 2012 (UTC)

Sounds good to me. But first, let me share my perspective on why the lead should be fundamentally transformed. I believe the most important reader of this article is the undecided voter. It appears you are a legal scholar, and I understand your efforts to have everything be up-to-snuff from a legal perspective, but I will venture to say that for every lawyer that reads this, there will be 100 non-legal types just looking for basic understanding, and they need to be accomodated. This voter is here because she wants to understand what all the fuss is about. Obamacare must be important because the pundits are saying it could decide the 2012 elections, and she wants to vote for the right candidates. If this law sounds like a good thing, then she will probably vote progressive to keep it from being repealed. If at the end of the lead, she is left with the impression that "there's no real problem here, other than a hyper-partisan political system" she probably won't bother to read any further. I think this is the likely outcome with the present lead. She deserves an article that presents, or at least acknowledges, how devisive this bill is. Below are various snippets from the current lead. The "take-aways" are what I believe many readers might interpret the snippet to mean. They often resemble a "talking point" for the "pro" side. They are often "half-truths" (which wiki says are the accepted norm of political speech these days) The "Counterpoints:" are some of the possible counter-arguments, and can be viewed as "con" talking points/half-truths. Importantly, these ideas are not verified, or reliably sourced. I believe they are probably out there in kinder,gentler words, but I have not gone looking for them. They are offered to illustrate the point.

I don't propose using opposing pairs of half-truths to describe PPACA. The pairs are presented to illustrate the presence of what I believe is a hidden bias.

In my opinion,the Actshould described in terms of:
 * what it does for, and to, various groups of citizens
 * how it does it
 * what it costs, who pays for it, and how is the money obtained
 * the expected outcomes

Finally, I want to be clear that the comments below are not meant to criticize any editor who may have contributed to the current content. I'm sure it is written in good faith based on the RSs they were working with.

Examples from the current lead:

.... it represents the most significant regulatory overhaul of the U.S. healthcare system since the passage of Medicare and Medicaid in 1965.[3]

Take-away: They are going to make some significant improvements to the healthcare system, but not on the same scale as Medicare and Medicaid. It sounds like Medicare is going to be improved, and I already like Medicare. Great!

Counterpoints: This is faint praise of PPACA. PPACA outweighs Medicare and Medicaid in many ways. One of the reasons some are against PPACA is the sheer size and reach of the bill. To say that it's less significant than Medicare/Medicaid is deceptive. Medicare/medicaid is a comparatively simple statute, imposing a new employment tax (since shown to be woefully inadequate) to provide single-payer healthcare insurance to a clearly defined group of citizens, the elderly. With the PPACA, much of the authority to regulate the healthcare system is taken from the states and nationalized. Industry-specific taxes are levied, the mandate is (almost) novel. The funding is highly progressive/redistributionist.

PPACA is aimed primarily at decreasing the number of uninsured Americans and reducing the overall costs of health care.

Take-away: That all sounds great. Nobody wants to be uninsured, and I can't wait until my costs go down.

Counterpoints: They are going to force people that presently choose to buy no insurance or minimal/catastrophic insurance to buy near-Cadillac insurance, and then lump everybody together in the same "pool" so the health-conscious, cost-conscious folks can help pay the premiums of the couch potatoes and the "its free so I might as well use it" crowd. (Have you ever been to a fancy restaurant with a group of ten or more and split the bill equally? How did that work out for you?)  They claim they are going to "bend the cost curve" (reduce the rate of increase) using questionable assumptions and with substantial uncertainty in the "out years". Following the Supreme Court ruling, there is now uncertainty about how many states will even implement the Medicaid Expansion.

It provides a number of incentives, including subsidies, tax credits, and fees, to employers and uninsured individuals in order to increase insurance coverage.[4]

Take-away: Ooooh, incentives are good. Too bad there aren't any "refundable tax credits" in there, I really like those. I'm a little confused about the "incentive...fee...to employers" though, but it's probably a good thing.

Counterpoints: I'm pretty sure these tax credits are "refundable" for many of the recipients. (but it has such a negative connotation. Well perhaps not, because many don't even know that it means "free handout from the government"...) Most people think an incentive is the good thing that happens when you are compliant. The fee (tax) is the bad thing that doesn't happen when you are compliant. Call it a dis-incentive, an inducement, a penalty, or coersion (my favorite), but don't call it an incentive. This is the kind of obfuscation often found in the writings of biased RSs, on either side of an issue. Subtle but effective.

PPACA requires insurance companies to cover all applicants and offer the same rates regardless of pre-existing conditions or gender.[5][6]

Take-away: That is obviously the only fair way to do things. Counterpoints: What about the premium increases for people without pre-existing conditions and for every male? Pre-existing conditions is a serious problem, but is this the only way to fix it? On gender; great, now every male (gay, straight, married, single) gets to pay his fair share toward the potential fertility-related costs of every female (gay, straight, married, single). No more choosing the health plan that does, or does not, include maternity coverage. Odd how that choice is so easily dismissed, while the other somewhat related "choice" is so fiercely defended. One more blow against the institution of marriage. Actually, I suppose a lot of people see this for what it is, but don't speak out for fear of being labeled sexist or uncompassionate. These "selling points" should be labeled as what they are, "premium cost redistribution mechanisms".

The Congressional Budget Office projected that PPACA will lower both future deficits[7] and Medicare spending.[8]

Take-away: Great, this is going to reduce government spending, including Medicare. Now Medicare won't go broke so soon, and the national debt will be smaller.

Counterpoints: Even though there is obviously massive new government spending, the mention of reduced deficits, in the absence of any mention of new revenues and offsets, easily leads to the erroneous conclusion that net spending is reduced. I believe the CBO also cites the net increase in Federal spending. That is the number that should be presented. I wouldn't mention the increase in the national debt; don't want to open the "unified budget, intra-governmental debt" can of worms. (Yes, I know "going broke" is a Tea Party "meme". ~I love that word)

...the newly Republican-controlled House of Representatives has repeatedly voted to repeal PPACA.[11]

Take-away: Why are those Republicans wasting their time by trying to repeal this law? They are just showboating. They should work on something more important like passing a budget or raising the debt ceiling.

Counterpoints: Why doesn't Harry Reid just let one of these bills come to a vote in the Senate, get everyone on the record, and move on to something like passing a budget or raising the debt ceiling?

Conservatives have also mounted a number of legal challenges against PPACA; after mixed success in lower courts, on June 28, 2012, the Supreme Court upheld the constitutionality of much of the Act in the case of National Federation of Independent Business v. Sebelius.[12][13]

Take-away: After all that time and expense, caused by those litigious Conservatives and their shot-gun blast of lawsuits, the Supreme Court says the law is mostly constitutional, and there apparently aren't any problems worth mentioning.

Counterpoints: This case was decided 5/4 and hinges on the mandate being constitutional only because the penalty can be construed to be a tax. Ironically, if it had been called a tax during the debate, it might not have passed. The Medicaid Expansion penalty was found to be coercive, and has been reduced, leading several states to say they will not participate. We may not have seen the end of court challenges to this legislation. Perhaps a carrot can be so big it is "entrapment" (or did they already rule on that?)

Remedy: I think a few brief facts about projected results can tell the story: e.g.


 * Reduce uncompensated emergency room cost shifting by $x by 20xx
 * Reduce total uninsured (including undocumented persons) from x million to y million by 20xx.
 * Increase % of population in single-payer system from x to y by 20xx
 * Change total government spending from x to y by 20xx
 * Change private sector healthcare spending from x to y by 20xx
 * Change private sector insurance premiums by x %
 * Increase life expectance of poor people by x years (I don't recall seeing that detail reported on, but I sure hope it's a big number because we are spending a lot of money in the name of this result. That's dangerous territory though, because it has a nasty effect on the sustainability of SS and Medicare...)

Based on the strictly partisan vote to achieve passage, the 5/4 Supreme Court decision, and public sentiment in favor of repeal, it would seem reasonable that the article would inform the reader with about 1/2 "pro" and 1/2 "con". (Although it may be harder to find RSs for the "con" side) Essentially, I am trying to reach political balance or neutrality in the lead.

PPACA is a wide ranging bill not fully implemented until 2020(?). Some features are summarized below.

To reduce the number of uninsured; an additional X million citizens become eligible for Medicaid, y million become eligible for refundable tax credits for part or all(?)of their insurance expenditures, tax incentives for small businesses that provide insurance to their employees are provided, and most individuals and all larger businesses must purchase insurance or pay a substantial tax penalty. Z uninsured are expected to remain by 2020, including y million undocumented residents. To reduce or redistribute out-of-pocket expenditures (while necessarily increasing premium expenditures); establish national standards for minimum coverage, prohibit annual and lifetime insurance spending caps , eliminate the Part D (prescription drug) "doughnut hole", require certain preventive care to be free-of-charge (including contraception related drugs and procedures), prohibit rate-setting consideration of gender and pre-existing conditions while limiting consideration of age.

To provide partial funding for the bill; (10 year projected impact shown in [ ])reduce expenditures for Medicare Advantage [x million], reduce certain other Medicare expenditures, collect higher Medicare insurance taxes on the wealthy, tax "Cadillac" insurance policies, tax insurance companies and suppliers of certain medical devices, collect insurance mandate penalties,

PPACA reduces the number of uninsured citizens in various ways; expanded Medicaid eligibility, refundable tax credits to individuals with income between 100% and 400% of the poverty line and to small businesses. An income-based tax is imposed on most individuals and some businesses that fail to become insured.

PPACA is aimed primarily at decreasing the number of uninsured Americans and reducing the overall costs of health care. It provides a number of incentives, including subsidies, tax credits, and fees, to employers and uninsured individuals in order to increase insurance coverage. Additional reforms are aimed at improving healthcare outcomes in the United States while updating and streamlining the the delivery of health care. PPACA also affects certain aspects of the private health insurance industry and public health insurance programs. It requires insurance companies to cover all applicants and offer the same rates regardless of pre-existing conditions or gender. The Congressional Budget Office projected that PPACA will lower both future deficits and Medicare spending.

Nstrauss

Below is what I propose for the descriptive paragraph. It's hard to piece-meal this, and its too large to survive in the Article space, so I put it here for your (and any other's) reaction. You will note there are no citations. If it is accurate and NPV, then can it stand in the lead, because what follows in later parts of the article will amplify on this "summary" with appropriate RS?

PPACA is aimed primarily at reducing the number of uninsured and under-insured American citizens and reducing the overall cost of health care. Medicaid eligibility is expanded significantly, subject to individual state participation. Inducements, including premium subsidies, tax credits, and financial penalties, encourage the purchase of insurance by individuals and employers. Variability of premiums is reduced by requiring insurance companies to accept and rate all applicants regardless of pre-existing conditions or gender, and with limited consideration of age. The issue of under-insurance is addressed by establishment of national standards for the minimum level of coverage and the prohibition of annual and lifetime spending caps. Additional provisions are aimed at improving healthcare outcomes and streamlining healthcare delivery and administration. The various provisions are introduced over a period of several years.

New taxes and tax rate increases are levied on the healthcare and insurance industries, and the wealthy. Spending for Medicare Advantage is substantially reduced. The Congressional Budget Office projects that PPACA will lower future deficits and Medicare spending.

Although it could use some improvements, I strongly prefer the current version of the lead. Per WP:LEAD, the lead should generally be no more than four paragraphs. Thomas Pain's version is too much of an outline and is uninviting to the casual reader. I also think that it doesn't accomplish his stated goal of describing PPACA in a straightforward manner. My recommendation would be to make edits in a more piecemeal manner and we can follow WP:BRD for each one, as necessary. --Nstrauss (talk) 16:11, 24 July 2012 (UTC)

Thank you, Nstrauss, for pointing to LEAD and BRD, good new reading for me, especially LEAD. I have stripped out and italicized the key points from LEAD and use them below to propose an outline of content for the PPACA lead. Perhaps we can agree on the content first, and then flesh out the verbiage later. Here goes:

Paragraph 1: Introduction and Important aspects

name and aliases - PPACA, Reconciliation act, ACA, Obamacare

Who and when - Obama, passage date, signing date

Most important aspects/aims -
 * Affordability of Healthcare insurance to reduce number of uninsured and underinsured citizens
 * new taxes
 * reduction in Medicare Advantage expenditures
 * reduction in the cost of health care delivery

Paragraph 2 Establish context, why is it notable
 * Rapidly rising health care costs
 * unsustainable government obligations
 * cost-shifting due to unpaid emergency room services
 * cost-shifting due to "government low-balling"
 * uninsured "invincibles", adverse selection
 * Healthy uninsured "wealthy" not in the insurance pool
 * pre-existing conditions, non-portable insurance
 * coverage caps and dropped coverage

Paragraph 3 Summarize important points
 * Medicaid expansion
 * Premium subsidies
 * Penalties for non-compliance with insurance mandate
 * Establishment of national minimum coverage requirements
 * Taxes and spending cuts

Paragraph 4, Summarize controversies
 * Constitutionality of insurance mandate
 * Political statements, promises, and legislative tactics
 * Single payer model
 * Double counting of cost reductions
 * CBO assumptions
 * Death panels
 * Religious freedoms
 * Republican attempts to repeal the ACA

Paragraph 5, Developments after enactment Emphasis should be consistant with importanceThis will probably be a challenge, due to different opinions of importance of various aspects.
 * CLASS act repealed
 * 1099s repealed
 * Supreme Court ruling
 * Summary of most recent estimates of results; coverage, costs, etc.
 * Summary of most recent estimates of results; coverage, costs, etc.

Everything covered in the lead should be covered in the remainder of the article.Some additional details may be needed, but I think most of it is in there....

Create interest but don't tease the reader. I think there is some teasing in the current lead:  e.g. ..number of incentives...  Framework of subsidies...upheld the majority....

Avoid more than 4 paragraphs. I think this 2,700 page bill requires something more than a four-pound bag.

Use clear, accessible style with NPV. I think my style is clear, to the point of being blunt. Others will keep me on the NPV train. Hopefully this is a more straightforward approach than my previous effort.Thomas Pain 67 (talk) 17:28, 25 July 2012 (UTC)Thomas Pain 67 (talk) 17:47, 25 July 2012 (UTC)

The lead section of a Wikipedia article is the section before the table of contents and the first heading. The lead serves as an introduction to the article and a summary of its most important aspects. The lead should be able to stand alone as a concise overview. It should define the topic, establish context, explain why the topic is notable, and summarize the most important points—including any prominent controversies. The emphasis given to material in the lead should roughly reflect its importance to the topic, according to reliable, published sources, and the notability of the article's subject is usually established in the first few sentences. Significant information should not appear in the lead if it is not covered in the remainder of the article. While consideration should be given to creating interest in reading more of the article, the lead should not "tease" the reader by hinting at—but not explaining—important facts that will appear later in the article. The lead should normally contain no more than four paragraphs, be carefully sourced as appropriate, and be written in a clear, accessible style with a neutral point of view to invite a reading of the full article.

PPACA is aimed primarily at decreasing the number of uninsured and underinsured American citizens by improving the affordability of healthcare insurance. Its provisions are phased in over several years.

It expands Medicaid eligibility for the poor, subject to individual state participation. Coverage of low and middle-income individuals is encouraged by income-based subsidies. Small employers are offered health care premium subsidies. A tax is levied on most individuals that fail to become insured. Businesses employing 50 or more persons are subject to a tax if they fail to provide healthcare insurance.[4]

The issue of underinsurance is addressed by the establishment of national standards for the minimum level of insurance coverage, the prohibition of individual spending caps, and exclusion of pre-exising conditions and gender from rate-setting.

Additional reforms are aimed at healthcare outcomes and reducing the costs to deliver healthcare services.[5][6]

The PPACA levies several new or increased taxes. These are paid primarily be the wealthy and the medical and insurance industries. Spending for Medicare Advantage is reduced substantially. The Congressional Budget Office projects PPACA will lower both future deficits[7] and Medicare spending in comparison to prior legislation.[8] On June 28, 2012, the Supreme Court largely upheld the constitutionality of PPACA in the case of National Federation of Independent Business v. Sebelius.[9][10]

DOMA The Defense of Marriage Act (DOMA) (Pub.L. 104-199, 110 Stat. 2419, enacted September 21, 1996, 1 U.S.C. § 7 and 28 U.S.C. § 1738C) is a United States federal law that defines marriage as the legal union of one man and one woman. The law passed both houses of Congress by large majorities and was signed into law by President Bill Clinton on September 21, 1996. Under the law, no U.S. state or political subdivision is required to recognize a same-sex marriage treated as a marriage in another state. Section 3 of DOMA codifies the non-recognition of same-sex marriage for all federal purposes, including insurance benefits for government employees, Social Security survivors' benefits, and the filing of joint tax returns.

Clinton and key legislators have changed their views and advocated DOMA's repeal. The Obama administration announced in 2011 that it had determined that section 3 was unconstitutional and, though it would continue to enforce the law, it would no longer defend it in court. In response, the House of Representatives undertook the defense of the law on behalf of the federal government in place of the Department of Justice (DOJ).

Section 3 of the DOMA has been found unconstitutional in a California bankruptcy case, a California class action suit on the part of public employees, several federal district court judges in three circuit court jurisdictions, and by a unanimous United States Court of Appeals for the First Circuit three-judge panel. As of July 17, 2012, there are three petitions for certiorari before the United States Supreme Court seeking review of decisions that have declared DOMA's section 3 unconstitutional. PPACA The Patient Protection and Affordable Care Act (PPACA),[1] informally referred to as Obamacare,[2] is a United States federal statute signed into law by President Barack Obama on March 23, 2010 after nearly a year of overall consideration by both chambers of Congress. The law (along with the Health Care and Education Reconciliation Act) is the principal health care reform legislation of the 111th United States Congress.

The PPACA law hopes to provide individuals not already subject to a designated qualified health benefits plan, or employers not currently offering their workforce such benefit plans, with a number of incentives, phased in over time, to secure coverage via a framework of subsidies, tax-credits and/or fees.[3] Additional reforms intend to improve healthcare outcomes in the United States overall while updating the manner and streamlining the costs surrounding the delivery of those healthcare services. The Act also affects certain aspects of the private health insurance industry and public health insurance programs. It bars insurance companies from considering pre-existing conditions or gender in coverage decisions, requiring them to cover all applicants and offer the same rates regardless of health status or gender.[4][5] The Congressional Budget Office projected PPACA will lower both future deficits[6] and Medicare spending.[7] Strawman In my opinion, the lead of this article isn't very clear about what the PPACA is, or what it does, or the ongoing issues surrounding it. I took a look at the lead of the DOMA article (Defense of Marriage Act), a similar piece of legislation in many ways. Using that article as a guide, I put together the strawman below. The bulleted format is for brevity/clarity, due to the complexity of the Act. An alternative structure would be to use a bullet/sub bullet to interleave the Intent items with the Means items.

[I appologize that the links and formatting are lost. I edited this in a different program and cut/pasted it here. I'm sure there are errors and omissions in what I state; I am just trying to propose a different look/feel. I think that a reader would find him/herself more completely informed after reading this, compared to the current version. I try to use the words that best describe what the law means to the layman. Your comments are appreciated.]

The Patient Protection and Affordable Care Act (PPACA),[1] is a United States federal statute signed into law by President Barack Obama on March 23, 2010 after nearly a year of debate by both chambers of Congress. The law was narrowly approved using the reconciliation process to avoid a Republican filibuster. This law and the Health Care and Education Reconciliation Act are the principal health care reform legislation of the 111th United States Congress. Collectively they are, at times, informally referred to as the Affordable Care Act (ACA) and Obamacare. [2]

Key features of the legislation include; expanded eligibility for Medicaid, increased federal revenue and spending for healthcare, establishment of national coverage and underwriting standards for private health insurance, and various inducements for individuals to obtain, and private-sector employers to provide, private healthcare insurance.

The intent of the law is to:

Reduce the number of uninsured U. S. citizens Reduce the number of under-insured U. S. citizens Expand revenues for government-provided healthcare Reduce the cost of government-provided healthcare Promote the use of preventive medicine

The number of uninsured is reduced through:

Expanded Medicaid eligibility, at the discretion of individual States Insurance subsidies for individuals with incomes between 100 and 400% of the poverty level Insurance subsidies for small businesses Penalties collected by the IRS from individuals who don't show proof of health insurance Penalties collected by the IRS for some employers who fail to provide health insurance Requiring unmarried, uninsured adults up to 26? years of age to be eligible for coverage under their parents' insurance

The number of under-insured is reduced through:

Requiring private insurance to cover, at minimum, approximately 60% of the total cost of healthcare, eliminating "catastrophic" coverage. Banning annual and lifetime coverage limits in private insurance coverage Banning consideration of pre-existing conditions in acceptance, coverage, and rate-setting decisions

Revenue for government healthcare is expanded by:

Increasing the Medicare tax rate for the wealthy Imposing a new Medicare tax on unearned income for the wealthy Imposing a new excise tax on certain medical devices Imposing new taxes on the health insurance and pharmaceutical industries. Imposing a national sales tax on indoor tanning

The cost of government-provided healthcare is reduced by:

Reducing expenditures for Medicare Advantage Reducing certain Medicare payments for home health care and hospital services

The use of preventive medicine is promoted by requiring that private insurance cover certain preventive measures free of co-pay or deductible.

The Congressional Budget Office projects the PPACA will lower both future deficits[6] and Medicare spending in comparison to previously enacted legislation.[7] The PPACA increases the Gross National Debt. (I don't have a citation, but we all know that it is true...... and then there is the “double counting” issue.....)

The number of uninsured U S residents is expected to decline from 52 million to 22 million when the bill is fully implemented.

Two features of the law have been repealed since passage:

Increased reporting, to the IRS, of certain expenditures by businesses (1099s) The CLASS Act

Twenty-eight states, numerous organizations, and a number of private citizens filed actions in federal court challenging the constitutionality of the PPACA.[8][9] On June 28, 2012, in the case of National Federation of Independent Business v. Sebelius, the Supreme Court upheld the law, except for the penalty imposed on States that do not participate in the Medicaid expansion. The court found that the loss of all Medicaid funding was coercive, and should be limited to only those funds associated wth the expansion of Medicaid.[10][11][12]

Numerous Republicans and 2012 presidential candidate Mitt Romney have said they want to repeal this law. Thomas Pain 67 (talk) 17:52, 23 July 2012 (UTC) O W III reply Not much balance between contested points and is just a bullet analysis rather than a sectional analysis. A lot of good points are given that do need to be covered but I don't think its quite yet the layout for lede material. Plus PPACA is a far more intense piece of legislation than DOMA was & is being phased in over time to boot (the current lede looks more like DOMA's actually). -- George Orwell III (talk) 01:58, 24 July 2012 (UTC)

Twenty-eight states, numerous organizations, and a number of private citizens filed actions in federal court challenging the constitutionality of the PPACA.[8][9] On June 28, 2012, in the case of National Federation of Independent Business v. Sebelius, the Supreme Court upheld the majority of the law.[10][11][12]